The Stark Act and the closely related anti-bribery law 30 years ago were important regulations designed to protect the patient community from fraud and abuse. However, given the evolution of today`s healthcare system, and in particular the transition from fee-based reimbursement to value-based reimbursement, Stark Law is now a barrier to the evolution of care coordination. The U.S. Department of Health and Human Services` Office of the Inspector General (OIG) includes the Stark Act as one of the top five federal fraud and abuse laws that apply to physicians. Other laws include the Anti-Bribery Act (AKS), the False Claims Act (FCA), the Exclusion Authorities and the Civil Fines Act (CMPL). Read on to learn the definition of Stark`s law, how it has evolved over the years, and what designated health services (DHS) are. Learn about the importance of the Stark Act and how it is classified by the U.S. government. Investigate the consequences of violations and exceptions to the Stark Act. Finally, learn how legal assistance helps you understand and follow the Stark Act. The qui-tam cases raised by whistleblowers were very effective in helping the government raise funds for claims that violated the Stark Act. Cases involving violations of the Stark Act often involve violations of the Anti-Bribery Act, which prohibits payments to induce the use of government-funded health services. Whistleblowers play an important role in protecting the health and safety of patients.

Some of the biggest hospital comparisons that covered Stark`s alleged violations include: Even with the best of intentions, there`s always a chance you could violate Stark`s law if you don`t understand its implications. One of the largest cases of whistleblowing of Stark violations was filed by Phillips & Cohen clients against Adventist Health Systems. The whistleblower lawsuit alleged a scheme to pay doctors excessive compensation in exchange for referring patients to Adventist hospitals, clinics and other ambulatory services in Florida, North Carolina, Tennessee and Texas. If you need legal advice, contact us so we can help you and your healthcare team consistently comply with Stark`s law. Our team is ready to expand your knowledge and understanding of the Stark Law definition and Stark Law exceptions to protect your medical practice. If the relationship between the hospital and the doctor becomes a little too comfortable, the patient has the right to ask if the doctor is making medical decisions that are in the best interest of the patient. How can a patient trust a doctor who refers them to a hospital that pays the doctor? The January 2021 issue of Policy and Medicine Compliance Update provides an overview of. The definition of „immediate family member” is extremely broad, including a spouse; biological or adoptive parent, child or sibling; step-parent, son-in-law, half-brother or half-sister; father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law or sister-in-law; grandparent or grandchild; and spouse of a grandparent or grandchild.

The definitions of „group practice” and „office ancillary services” are even more specific and include details on office buildings, suite numbers, hours of operation, number of patient meetings, full-time and part-time physicians, independent contractors, internal references, staff monitoring, the name of the invoice, surcharges, etc. If you know of a qualified hospital, laboratory, or care facility that pays doctors to do business, you`re not alone. The Wall Street Journal says, „Self-referral has become a common practice among many groups of American doctors, referring everything from lab services to MRIs to companies that benefit them financially.” For example, the Stark Act prevents hospitals from paying incentives to providers if they meet certain quality measures and penalizes other providers for failing to meet certain agreed targets. Such arrangements are key elements of value-based care. „Referral” means a request for a specific service or medical service for Medicare Part B services and/or a plan of care that includes designated health services. The term „financial relationship” also includes agreements relating to investment interests, ownership and remuneration. Adventist paid the government $118 million to settle the whistleblower case. Matthew Hutt, CPA, CGMA, is a partner, AAFCPAs, a New England-based CPA and consulting firm. Congress first enacted the Stark Act in 1989 and a few years later passed additional legislation that expanded the scope of the law. Concerns about the Stark Rule`s bureaucratic value barriers were one of the top concerns raised by providers when CMS held listening sessions in 2017 as part of its „Patients over Paperwork” initiative. The millions of dollars and hundreds of hours spent complying with the administrative burden of the rule were cited as a significant burden that hindered patient care. As providers take responsibility for the overall cost of caring for their patients, the risks associated with self-referral have changed.

However, the ambiguities of the Stark Act have frozen many suppliers for fear that even advantageous agreements could violate the law, which can have serious and costly consequences. This has led healthcare providers to spend millions of dollars to comply with obscure regulations instead of using those dollars for patient care. It has also hindered the movement toward value, not only in Medicare, but among all payers, including Medicaid and private health plans. Other examples include the bona fide employment exception, the office-based attendant services exception, and the hospital-wide exception. Note that you must meet different requirements for each exception to be valid. Otherwise, you could be charged with breaking the law. This book is distributed under the terms of the Creative Commons Attribution 4.0 (creativecommons.org/licenses/by/4.0/) international license, which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, provided that you adequately credit the original author and source, provide a link to the Creative Commons license, and acknowledge any changes made.